Supplier Certificate of Conformance - ExcelSHE
|SUPPLIER CERTIFICATE OF CONFORMANCE |
|Purchase | Purchase order | | |Line Item No (s) | | |
|Order Data | | | | | | |
| | Part Number | | |
| | |
|Serial & Lot | Serial No (s) | | |
|Data | | | |
| | Lot No(s) | | |
| | |
|Sampling Data| Sampling Inspection | Sampling Plan | | | |
| | | | | | |
| | Yes No | ACL | | | |
| | |
|Specification| Reference Specification: | | |
|Data | | | |
| | | |
| | |
| | Country of Origin | | |
| | U.S. Other | | |
| | |
|CERTIFICATION |
| |
|I do hereby certify that the products and/or services listed above are of the quality specified and conform to all requirements of the purchase Order, |
|including: Quality Control Clauses, Design specifications, drawings, preservation, packaging, packing, marking, and physical identification |
|requirements. |
|Supplier Data| Company Name | | |
| | Address | | |
| | City | | |
| | |(Please Print Or Type Name & Title) | |
| | Signature Of Company | | |Date | | |
| |Quality Representative | | | | | |
| | |
CF 6-193B
|Instructions for Completion of |
|Cubic Defense Systems Form CF 6-193 |
|Purchase Order Data |
| |
|Purchase Order: Enter the Cubic Defense Systems Purchase Order Number for the product supplied in this shipment. |
| |
|Line Item No (s): Enter the Cubic Defense Systems Purchase Order Line Item Number for the product supplied in this shipment. It is permissible to have |
|this Certificate of Conformance cover multiple line items as long as the part numbers and lot data are the same. |
| |
|Part Number: Enter the part number for the product supplied in this shipment. The part number should match exactly the part number on the Cubic Defense|
|Systems Purchase Order. |
| |
|Revision: Enter the revision letter for the product supplied in this shipment. The revision letter should match exactly the Revision Letter on the |
|Cubic Defense Systems Purchase Order. |
| |
|Quantity: Enter the quantity of the product supplied in this shipment. Note the quantity shown in here shall only reflect the quantity of the product |
|in this shipment and may not be the total quantity listed on the Cubic Defense Systems Purchase Order. |
| |
|Description: Enter the name for the product supplied in this shipment. |
|Serial & Lot Data |
| |
|Serial No (s): Enter the serial number(s) for the product supplied in this shipment as applicable. |
| |
|Lot No (s): Enter the Lot Date/Lot Number/Batch Number as applicable. |
| |
|Shelf Exp.: If product has a limited shelf life, enter expiration date and indicate this date as either Date of Shipment (DOS) or Date of Manufacture |
|(DOM). |
|Sampling Data |
| |
|Sampling Inspection: Indicate if sampling inspection was used for inspection of the product supplied in this shipment by placing an X in the appropriate|
|box. |
| |
|Sampling Plan: Enter the sampling plan, if applicable, used for inspection of the product supplied in this shipment. |
| |
|AQL: Enter the Acceptable Quality Level, if applicable, used for inspection of the product supplied in this shipment. |
|Specification Data |
| |
|Reference Specification: Enter the specifications that the product supplied in this shipment is certified to meet as required by Cubic Defense Systems |
|purchasing agreements (i.e. Military specifications, Cubic Defense Systems specifications and drawings, Purchase Order requirements). |
| |
|Country of Origin: Indicate the country of origin of the product supplied in this shipment by placing an X in the appropriate box. For products with an|
|origin outside the U. S. Enter the name of the place of origin. |
|Supplier Data |
| |
|Company Name: Enter the name of your facility. |
| |
|Address: Enter the street address of your facility. |
| |
|City: Enter the name of the city where your facility is located. |
| |
|State: Enter the abbreviation of the state where your facility is located. |
| |
|Zip: Enter the Zip Code for your facility. |
| |
|Name & Title Of Company Quality Representative: Printer or type the name and title of the individual designated to sign as the quality representative|
|for your facility. |
| |
|Signature of Company Quality Representative: The individual designated to sign as the quality representative for your facility shall place this |
|signature here. Certificates of Conformance without a signature are not acceptable at Cubic Defense Systems. |
| |
|Date: Enter the date that the Certificate of Conformance is signed. |
|Cubic Defense Systems Quality Clause C-4 |
| |
|A certificate of conformance, Cubic Defense Systems Form CF 6-193 or equivalent, is required with each shipment. The certificate shall include: Cubic |
|Defense Systems purchase order and line item number, part number, and applicable specifications. The certificate must have: the signature of a quality |
|representative, the title of the signing individual, and the date of signature. |
2 CF 6-193B
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